title: Should we pay the student? A randomised trial of financial incentives in medical education.
abstract: BACKGROUND
  Financial incentives are effective in moderating physician and patient behaviour, but they have not been studied in the context of medical education.
  
  
  OBJECTIVE
  This study assessed whether financial incentives can motivate students to acquire electrocardiogram (ECG) interpretation skills.
  
  
  METHODS
  Students enrolled for a cardio-respiratory teaching module (n = 121) were randomised to an intervention (financial incentive) or a control (book voucher raffle) condition. All students took three validated exams of ECG interpretation skills (at module entry, module exit and seven weeks later). Only the exit exam was financially incentivised in the intervention group. The primary outcome was the proportion of students who correctly identified ≥60% of clinically important diagnoses in the exit exam.
  
  
  RESULTS
  Financial incentives more than doubled the odds of correctly identifying ≥60% of diagnoses in the exit exam (adjusted odds ratio 2.44, 95% confidence interval 1.05-5.67) and significantly increased student learning time. However, there was no significant effect on performance levels in the retention exam.
  
  
  CONCLUSIONS
  Financial incentives increase reported learning time and examination results in the short-term. The lack of a sustained effect on performance suggests that financial incentives may foster a superficial or strategic rather than a deep approach to learning.
authors.affiliation: University Medical Centre Göttingen, Germany. raupach@med.uni-goettingen.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Raupach
authors.forename: Jamie
authors.initials: J
authors.lastname: Brown
authors.forename: Anna
authors.initials: A
authors.lastname: Wieland
authors.forename: Sven
authors.initials: S
authors.lastname: Anders
authors.forename: Sigrid
authors.initials: S
authors.lastname: Harendza
mesh_terms: D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000191:economics*; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D009042:Motivation; D012201:Reward; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult